title: Injury and liability associated with cervical procedures for chronic pain.
abstract: BACKGROUND
  Prompted by an increase in interventional pain treatments performed at the level of the cervical spine, we investigated the characteristics and patterns of injury in malpractice claims collected from January 1, 2005 to December 31, 2008.
  
  
  METHODS
  We compared claims arising from cervical pain treatments with all other chronic pain claims collected from the American Society of Anesthesiologists' closed claims database between 2005 and 2008. Claims for spinal cord injury underwent in-depth analysis for mechanisms of injury and use of sedation during the procedure.
  
  
  RESULTS
  Claims related to cervical interventions represented 22% (64/294) of chronic pain treatment claims. Patients who underwent cervical procedures were healthier (American Society of Anesthesiologists' score, 1-2; P < 0.001) and were more often women (P = 0.011). Of the patients who underwent a cervical procedure, 59% experienced spinal cord damage compared with 11% of patients with other chronic pain (P < 0.001), with direct needle trauma as the predominant cause (31%). General anesthesia or sedation was used in 67% of cervical procedure claims associated with spinal cord injuries but in only 19% of cervical procedure claims not associated with spinal cord injuries (P < 0.001). Of the patients who underwent cervical procedures and had spinal cord injuries, 25% were nonresponsive during the procedure compared with 5% of the patients who underwent cervical procedures and did not have spinal cord injuries (P < 0.05, κ = 0.52).
  
  
  CONCLUSIONS
  Injuries related to cervical interventional pain treatment were often severe and related to direct needle trauma to the spinal cord. Traumatic spinal cord injury was more common in patients who received sedation or general anesthesia and in those who were unresponsive during the procedure. Further studies are crucial to define the usefulness of cervical interventions and to improve their safety.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA. jprathmell@partners.org
authors.forename: James P
authors.initials: JP
authors.lastname: Rathmell
authors.forename: Edward
authors.initials: E
authors.lastname: Michna
authors.forename: Dermot R
authors.initials: DR
authors.lastname: Fitzgibbon
authors.forename: Linda S
authors.initials: LS
authors.lastname: Stephens
authors.forename: Karen L
authors.initials: KL
authors.lastname: Posner
authors.forename: Karen B
authors.initials: KB
authors.lastname: Domino
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology; D002574:Cervical Vertebrae / Q000293:injuries; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D016602:Needlestick Injuries / Q000209:etiology*; D012955:Societies, Medical; D013119:Spinal Cord Injuries / Q000209:etiology*; D014481:United States